Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis

Sarkozy, Clémentine; Baseggio, Lucile; Feugier, Pierre; Callet‐Bauchu, Evelyne; Karlin, Lionel; Seymour, John F.; Lebras, Laure; Michallet, Anne‐Sophie; Offner, Fritz; Dumas, Olivier; Traverse-Gléhen, Alexandra; Ffrench, Martine; López‐Guillermo, Armando; Berger, Françoise; Felman, Pascale; Salles, Gilles

doi:10.1111/bjh.12675

Cited by 35 publications

(22 citation statements)

References 31 publications

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“…Leucocytosis at presentation appears to be associated with a poor prognosis; particularly, there is a correlation with the degree of leucocytosis with increased mortality and decreased disease-free survival. In addition, associated nodal involvement compared with a pure leukaemic phase contributes to a poorer prognosis 1 3 5. These findings are consistent with the poor outcome demonstrated in our patient, whose demise was just 1.5 months from diagnosis.…”

Section: Discussionsupporting

confidence: 90%

Follicular lymphoma presenting as hyperleucocytosis

Cochrane

Aljadir

2020

BMJ Case Rep

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Follicular lymphoma is the second most common subtype of non-Hodgkin's lymphoma affecting adults. Clinically, follicular lymphoma is generally indolent, most often presenting as a painless peripheral lymphadenopathy; however, a leucocytosis at presentation is exceedingly rare. We present the case of a 63-year-old woman with follicular lymphoma with a presenting hyperleucocytosis at diagnosis of 1 327 000/μL demonstrated on laboratory analysis work while hospitalised for progressive weakness. fluorescence in situ hybridization (FISH) panel was consistent with follicular lymphoma, which was positive for B-cell leukaemia/lymphoma 2 and negative for MYC Proto-Oncogene. Cytoreduction with rituximab-containing therapy was initiated, with the patient ultimately expiring. A leukaemic phase at presentation appears to be associated with poor outcome. The findings from our case, in addition to others, have potential implications in regard to prognostic utility. The current prognostic tool used to estimate overall survival for follicular lymphoma, Follicular Lymphoma International Prognostic Index, does not take leucocytosis into account.

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Section: Discussionsupporting

confidence: 90%

Follicular lymphoma presenting as hyperleucocytosis

Cochrane

Aljadir

2020

BMJ Case Rep

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“…Sarkozy et al reported 7.4 % of their cases to have leukemic involvement and had shorter progression free and overall survival compared to a group of follicular lymphoma without a leukemic spill. More than 4×10 9 /L circulating lymphoma cells was found to have a bad prognosis 17. In the present study out of the four patients in leukemic phase one patient expired, the second one had an initial response to chemotherapy, and the other two were lost to follow up.…”

Section: Discussionmentioning

confidence: 45%

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Sylvia

Dey

Basu

et al. 2016

Mediterr J Hematol Infect Dis

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IntroductionFollicular lymphoma (FL) is an indolent lymphoproliferative disorder of B-cells with variable clinical behavior. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia.Materials and methodsCases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details, and immunohistochemical markers CD20, CD10 and BCL-2 were recorded in all the cases.ResultsOf the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill were seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4.ConclusionThe incidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. The study highlights features of low grade with high proliferation index, granulomatous response, leukemic involvement, and transformation to high grade lymphoma.

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“…In a recent report from Japan, Kodaira and colleagues showed that a leukemic presentation, which accounted for 21% of the cases, portends a worse progression-free survival (PFS) in patients with FL treated with chemoimmunotherapy [22]. More recently, Sarkozy and colleagues identified a leukemic phase in 7% of patients with FL, which was associated with a shorter PFS, independent of the FL international prognostic index (FLIPI) score and beta-2-microglobulin levels [23]. Of note, both studies have been presented solely in abstract form.…”

Section: Discussionmentioning

confidence: 99%

Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature

et al. 2013

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Follicular lymphoma FL) is a prevalent subtype of non-Hodgkin lymphoma in the United States and Europe. Although, FL typically presents with nodal involvement, extranodal involvement has been rarely described. There is mounting evidence that leukemic presentation portends a worse prognosis in patients with FL. We describe 7 patients with a pathological diagnosis of FL who presented with a leukemic component. We also present data on patients with leukemic FL reported in the literature. Based on our results, leukemic FL seems to be associated with a worse prognosis. However, larger prospective studies are needed to confirm our findings.

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Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis

Cited by 35 publications

References 31 publications

Follicular lymphoma presenting as hyperleucocytosis

Follicular lymphoma presenting as hyperleucocytosis

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature

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